Correct!
3. Consolidation in the right lung
A large number of parenchymal chest injuries can result from blunt trauma incurred from a motor vehicle accident. These include pulmonary contusion, pleural injuries (pneumothorax, hemothorax), tracheal or bronchial tears, esophageal injuries and heart injuries (1). Laceration, tear, or disruption of the trachea or a major bronchus is life threatening. These injuries require surgical repair. Establishment of a secure and adequate airway is of primary importance. Patients with major bronchial lacerations or avulsions usually have massive air leaks. This results in the “fallen lung sign” where the lung falls away from the hilum. The esophagus is relatively protected from injury because its location in the posterior mediastinum. Blunt injuries of this organ are rare. However, when they do occur the injuries are usually caused by a sudden increase in esophageal luminal pressure resulting from a forceful blow. Injury usually occurs in the cervical region. Associated injuries to other organs are common. Physical clues to the diagnosis may include subcutaneous emphysema, pneumomediastinum, pneumothorax, or intra-abdominal free air.
There is clearly an area of consolidation extending to the right chest wall (Figure 2, black arrow). In addition, there is a large sac-like mass with air and fluid in the medial right chest (Figure 2, red arrows).
Figure 2. Admission chest x-ray showing an area of consolidation extending the right chest wall (black arrow) and a large sac-like mass with air and fluid in the right medial chest (red arrows).
A thoracic CT scan was performed to better define the abnormalities (Figure 3).
Figure 3. Selected static images from thoracic CT scan. Panels A-C: lung windows. Panels D-F: soft tissue windows. Lower left: movie of lung windows. Lower right: movie of soft tissue windows.
Which of the following is the appropriate next step regarding the patient’s large fluid and air filled sac in the right chest?